bronchiectasis · am j respir crit care med. 2014 mar 1;189(5):576-85. ... associated with...
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Bronchiectasis
The team
Medical staff
Dr Adam Hill
Vacant post- Dr Lithgow
Dr Ruzanna Frangulyan
Specialist Trainee
Specialist staff
Kim Turnbull
Denise
Gillian
Jenny Scott
Jo Pentland
Research nurses
Sam Donaldson
Andrea Clarke
Researchers
Dr Pallavi Bedi
Dr Manjit Cartlidge
Yang Zhang
Khatarina Singh Kang
Elena Perez Fernandez
Cathy Doherty
Prof John Govan
Dr Thamarai Schneiders
Prof Adriano Rossi
Dr Donald Davidson
Dr Kev Dhaliwal
Local Developments
Launch of website www.bronchiectasis.scot.nhs.uk
Support for patients at Mon clinic
Breathtakers Action for Bronchiectasis meetings
Bronchiectasis Severity Index
63 14
8
7.2
2.3 5.4
Idiopathic post infective
Post TB
ABPA
RA
IBD
Others
5 European Centres
• Dundee
• Edinburgh
• Leuven
• Milan
• Newcastle
Total study
population 1310
Am J Respir Crit Care Med. 2014 Mar 1;189(5):576-85.
•Aim was to identify independent predictors of hospitalization
and mortality over 4-year follow-up using clinical endpoints
•External validation
•Prospective study 2008-2012
BSI Score points 0-25
Score Points
Age 50-69 2; 70-79 4; 80+ 6
BMI <18.5 Kg/m2 2
FEV1 % Predicted 50-80 1; 30-49 2; <30 3
Previous hosp. admission 5
Exacs. Before study >3 2
MRC Score 4= 2; 5=3
Pseudomonas aeruginosa 3
Other PPMs 1
>3 Lobes or cystic Bx 1
0-4; 5-8; 9+ www.bronchiectasisseverity.com
BSI and Outcome
0
10
20
30
40
50
60
70
80
SGRQ % Hospital Admission % Mortality
0-4
5-8
9+
Research Fellows update
Dr Manjit Cartlidge
Finished 2 year project funded by CHSS
Studied stable patients and when they had an infection
Does the bacteria change during an infection?
Studied the use of the incremental walking test
Manjit is analysing the data and will present findings
hopefully at the next meeting!
Research Fellows update
Dr Pallavi Bedi
Completing 3 year PhD project funded by CSO
Studying whether there is deficiency of natural lipids are
associated with bronchiectasis and a potential new non
antibiotic treatment
Look forward to seeing the results but preliminary data looks
exciting
No Validated CT Scoring Systems in Bronchiectasis
Sputum purulence
ERJ 2009;34:361-4
N=141
MUCOID
MUCUPURULENT
PURULENT
M
I
L
D
S
E
V
E
R
E
CT scoring in post-infective and
idiopathic Bx (never or <5 PY)
With multivariable logistic
regression analysis (n=184)
Two key factors in linking
radiological and clinical
severity
A] degree bronchial dilatation
B] no. bronchopulmonary
segments with emphysema
Em
phys
ema on C
T
No em
phys
ema on C
T
0
20
40
60
80
Ne
utr
op
hil e
las
tas
e (p
g/m
l)
*
0 50 100 1500
50
100
150
1- Specificity
Se
ns
itiv
ity
ROC curve: Hospital admissions
0.75
0 50 100 1500
50
100
150
1- Specificity
Se
ns
itiv
ity
ROC curve: Sputum purulence
0.71
0 50 100 1500
50
100
150
1- Specificity
Se
ns
itiv
ity
ROC curve: % Predicted FEV1
0.79
Research Fellows update
Yang Zhang
Completed MSc and awarded a distinction
Studied how to best process sputum samples for those
patients infected with the organism Haemophilus influenzae
Awarded a Chinese Fellowship and doing a PhD exploring
the importance of Haemophilus influenzae in bronchiectasis
2h 4h 6h 24h
48h
0
50
100
150
200
71%
124% 134%110%
81%
Via
ble
rate
(R
T)
0h 2h 4h 6h 24h
48h
103
104
105
106
107
108
109
1010
543
7
2
8910
p=0.24
p=0.52p=0.58
p=1.00
p=0.83
6
11
c.f.u
/ml (R
T)
24h
48h
0
50
100
150
68%
49%
Via
ble
ra
te(
4C)
0h 24h
48h
103
104
105
106
107
108
109
10102345678910
p=0.25p=0.10
11
c.f
.u/m
l (4C
)
24h
48h
0
20
40
60
80
100
4.3%8.0%
Via
ble
rate(
-20C)
0h 24h
48h
103
104
105
106
107
108
109
12345
p=0.03
p=0.03
11
c.f.u
/ml (-
20C
)
24h
48h
0
20
40
60
80
100
12%
3.8%V
iable
rate(
-70C)
0h 24h
48h
103
104
105
106
107
108
109
1010
6789
p=0.03
p=0.03
1011c
.f.u
/ml (
-70C
)
4-20
-70
0
50
100
150
0.2%
91%
13%
Via
ble
rate
(G
lycero
l)
0h 4-2
0-7
0102
104
106
108
1010
131415161718
p=1.0
p=0.03
p=0.03
c.f.u
/ml (G
lycero
l)
Research Fellows update
Khatarina
Awarded and MSc
Studied whether IgG2 deficiency leads to worse
bronchiectasis
Conducting a PhD exploring the importance of IgG2
deficiency in how neutrophils and macrophages eat bacteria
Deficient Controls P-value
Bacterial Pathogens Number Percent Number Percent
P. aeruginosa 8 13 2 5 0.08
P. aeruginosa and
coliforms 13 21 5 12 0.02
Gram-positive 13 22 10 25 1
Gram-negative 34 78 26 75
Mean Median 25th 75th Statistical test
performed P-value
Deficient 7 6 2 8
MWU-test 0.03
Control 4 4 2 5
Mean Median 25th 75th Statistical test
performed P-value
Deficient 9 9 6 12 t-test 0.002
Control 5 4 3 8
BSI
Chest
infections
Research Fellows update
Elena
Completing MSc
Studying the importance of Stenotrophomonas maltophilia in
bronchiectasis
Will present her results at a future meeting
Planning to become a Medical Dr
Research Fellows update
Cathy
Supporting team doing microbiology
Starting to study whether cross infection is a possibility or
not- no evidence to date
Will present her results at a future meeting
Other studies in Bx
1] POL7080- update- a new anti-pseudomonal antibiotic
2] Statin in patients with Pseudomonas aeruginosa- exciting 3
month study and will present results at a future meeting
3] Study trying to shorten IV antibiotic treatment from 14
days to either 7d or 10d- antibiotics stopped if bacteria are
present in low numbers or not present
MRC Funded Bronchiectasis Research Network 0.7M
Led by Dr A de Soyza in Newcastle
Edinburgh one of the UK Centres
Following 175 Patients over 2-3 years and storing DNA
15-20 Patients followed every 3m- CLINIMETRICS study
Linking in with European Database EMBARC
IMI grant- iABC study
International study
Led by Stuart Elborn Belfast
30M Euros funded by
European Union and Industry
Edinburgh lead phase 3 study
of inhaled tobramycin in
bronchiectasis (partner Eva
Polverini Spain)
Research with Dr Dhaliwal
Novel optical imaging
Pilot studies to determine whether we can label activated
white cells in the airways and label bacteria in the alveoli- the
part of the lung involved in gas exchange
System and Integration
Optical fibre
Novel
sensors
(Probes
and
reporters)
Detect and measure
physical conditions
and biomedical
markers in real-time
data integration
and conversion
to information
for decision
making
an innovative approach to
the integration of sensing
technologies into systems.
Instrument hardware
Green – ex vivo human lung, red – bacteria, NIR -
cells
A B
E
C
Ex vivo CF Lung with segmental NAP administration